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TRICARE Select Enrollment Reinstatement Form

TRICARE Select Group A retirees and family members who were disenrolled for non-payment can submit this form by June 30, 2021, to request reinstatement and pay fees due. Reinstatement requires automatic payment set up for future fees. 

After June 30, enrollment changes can only be made after a qualifying life event or during TRICARE's annual Open Season.

  • Created: Apr 30, 2021
  • Modified: Apr 30, 2021
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